Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies

Iatrogenic vascular air embolism is a relatively infrequent event but is associated with significant morbidity and mortality. These emboli can arise in many clinical settings such as neurosurgery, cardiac surgery, and liver transplantation, but more recently, endoscopy, hemodialysis, thoracentesis, tissue biopsy, angiography, and central and peripheral venous access and removal have overtaken surgery and trauma as significant causes of vascular air embolism. The true incidence may be greater since many of these air emboli are asymptomatic and frequently go undiagnosed or unreported. Due to the rarity of vascular air embolism and because of the many manifestations, diagnoses can be difficult and require immediate therapeutic intervention. An iatrogenic air embolism can result in both venous and arterial emboli whose anatomic locations dictate the clinical course. Most clinically significant iatrogenic air emboli are caused by arterial obstruction of small vessels because the pulmonary gas exchange filters the more frequent, smaller volume bubbles that gain access to the venous circulation. However, there is a subset of patients with venous air emboli caused by larger volumes of air who present with more protean manifestations. There have been significant gains in the understanding of the interactions of fluid dynamics, hemostasis, and inflammation caused by air emboli due to in vitro and in vivo studies on flow dynamics of bubbles in small vessels. Intensive research regarding the thromboinflammatory changes at the level of the endothelium has been described recently. The obstruction of vessels by air emboli causes immediate pathoanatomic and immunologic and thromboinflammatory responses at the level of the endothelium. In this review, we describe those immunologic and thromboinflammatory responses at the level of the endothelium as well as evaluate traditional and novel forms of therapy for this rare and often unrecognized clinical condition

Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies

Iatrogenic vascular air embolism is a relatively infrequent event but is associated with significant morbidity and mortality. These emboli can arise in many clinical settings such as neurosurgery, cardiac surgery, and liver transplantation, but more recently, endoscopy, hemodialysis, thoracentesis, tissue biopsy, angiography, and central and peripheral venous access and removal have overtaken surgery and trauma as significant causes of vascular air embolism. The true incidence may be greater since many of these air emboli are asymptomatic and frequently go undiagnosed or unreported. Due to the rarity of vascular air embolism and because of the many manifestations, diagnoses can be difficult and require immediate therapeutic intervention. An iatrogenic air embolism can result in both venous and arterial emboli whose anatomic locations dictate the clinical course. Most clinically significant iatrogenic air emboli are caused by arterial obstruction of small vessels because the pulmonary gas exchange filters the more frequent, smaller volume bubbles that gain access to the venous circulation. However, there is a subset of patients with venous air emboli caused by larger volumes of air who present with more protean manifestations. There have been significant gains in the understanding of the interactions of fluid dynamics, hemostasis, and inflammation caused by air emboli due to in vitro and in vivo studies on flow dynamics of bubbles in small vessels. Intensive research regarding the thromboinflammatory changes at the level of the endothelium has been described recently. The obstruction of vessels by air emboli causes immediate pathoanatomic and immunologic and thromboinflammatory responses at the level of the endothelium. In this review, we describe those immunologic and thromboinflammatory responses at the level of the endothelium as well as evaluate traditional and novel forms of therapy for this rare and often unrecognized clinical condition

Influência do manejo da irrigação no meloeiro rendilhado cultivado em ambiente protegido Irrigation management on net-melon fruits cultivated under greenhouse

Visando a avaliar a cultura do melão rendilhado em função do manejo da irrigação, foi realizado um experimento em casa de vegetação com a cultivar Bônus nº 2, na área experimental do Departamento de Engenharia Rural da Escola Superior de Agricultura "Luiz de Queiroz" - ESALQ/USP. Foram avaliados dois sistemas de manejo (tensiômetro e lisímetro de tensão controlada), e dois níveis de fertilidade (presença e ausência de fertilizantes). O lisímetro de tensão controlada é um dispositivo que utiliza cápsula porosa, capaz de fornecer água automaticamente, acoplado a um tubo de Mariotte, que permite realizar leituras de volume de água consumido pela planta. Para os tratamentos com lisímetro de tensão controlada, a porosidade livre de água média (PLA) foi de 15%; já para os irrigados com base nos tensiômetros, a PLA permaneceu em média 35%, favorecendo boa relação ar-água durante todo o experimento. Com relação à variação temporal do potencial matricial do solo (média das três profundidades), os tratamentos com tensiômetro apresentaram valores médios de tensões com desvios de 9,10%, enquanto, para os tratamentos com lisímetro de tensão controlada, os desvios foram de 1,33%. Com manejo da irrigação por tensiômetros, sem adição de fertilizantes, a massa média dos frutos (1.070,4 g) quase duplicou em relação ao padrão mínimo comercial (550 g). Adicionando a fertirrigação nesse manejo, o incremento passou a ser de 4,5 vezes (2.493,8 g). O meloeiro apresentou baixo rendimento em condição de porosidade livre de água inferior a 20%.<br>Aiming to evaluate net-melon fruits under irrigation management, it was carried out an experiment in greenhouse conditions. The experimental area was located at the irrigation farm of the Engineering Department of - Escola Superior de Agricultura "Luiz de Queiroz" - ESALQ/USP in Piracicaba, São Paulo, Brazil, planted with Bonus 2 cultivar. Two irrigation management systems were evaluated by tensiometer and tension lysimeter with two levels of solution fertility (presence and absence). Tension lysimeter is a device based on porous cap, capable of supplying water automatically to the plant through a Mariotte reservoir (constant hydraulic head). For the treatments with tension lysimeter, the average free water porosity (PLA) was 15%. For treatments with tensiometers, the PLA was 35% in average, favoring a good relation of air-water throughout the experiment. The temporal variation of the matrix potential in treatments by tensiometer, measured in three depths, presented an average deviation of 9.10% whereas treatments with tension lysimeter were 1.33%. The irrigation management by tensiometers without fertilizer obtained an average weight of the fruits (1,070.4 g) that was almost duplicated in relation to minimum commercial standard (550 g). However, by adding fertilizer in these plants the productivity increment was 4.5 times higher (2,493.8 g). The net-melon fruits presented a low productivity when the free water porosity was lower at 20%

Determinación del consumo de agua del duraznero por lisimetría Determination of water use in peach trees with a lysimeter

En el año 2004 se instaló un lisímetro de compensación de 2 x 2 x 0,80 m con capa freática constante en un monte de durazneros, con el objetivo de estudiar el consumo de agua de ese cultivo en la región sur del Uruguay. Las mediciones se hicieron en las tres primeras temporadas de crecimiento. El consumo en la primera temporada alcanzó valores de 5 mm d-1, equivalente a 56 L en el marco de plantación. En la segunda temporada llegó a 6 mm d-1 (68 L), aunque alcanzó valores extremos de más de 7 mm d-1. Cuando el árbol alcanzó su tamaño adulto, el consumo máximo se mantuvo alrededor de los 6 mm d-1, aunque este valor se alcanzó más temprano que en la temporada anterior. Este adelanto se correspondió con un mayor índice de área foliar (IAF). El coeficiente de cultivo (Kc) fue de alrededor de 1,2 en la primera temporada, y de 1,4 en las dos siguientes. Se calcularon los coeficientes de base (Kcb) y su valor se ajustó por el modelo tri-segmentado. Su valor fue de 0,91 en la primera temporada, 1,04 en la segunda y 1,20 en la tercera. Se hacen algunas observaciones metodológicas sobre el uso de este lisímetro, proponiéndose incorporar la variación de agua en el suelo a la ecuación de balance de volúmenes y se propone adicionar riego desde la superficie.<br>A compensation lysimeter with constant freatic water table of 2 x 2 x 0.80 m was installed in 2004 in a peach grove, in order to study the crop water consumption in the south of Uruguay. Measurements were taken in the first three growing seasons. Evapotranspiration at the first season reached 5 mm d-1, equivalent to 56 L in the whole area. In the second season, it went up to 6 mm d-1 (68 L), reaching extreme values of 7 mm d-1 and more. When the tree reached its adult size, the maximum consumption remained around 6 mm d-1, although this value was reached earlier than the season before. This early behavior came together with higher leaf area index (LAI). The crop coefficient (Kc) was around 1.2 in the first season, and 1.4 in the following two seasons. Basal crop coefficient (Kcb) was calculated and its value was adjusted by the tri-segmented model. The value was 0.91 at the first season, 1.04 in the second and 1.20 in the third. Some methodological observations are made regarding the lysimeter use. Adding the soil water changes to the mass balance equation is suggested, as well as incorporating irrigation from the surface

COVID‐associated non‐vasculitic thrombotic retiform purpura of the face and extremities: A case report

Abstract SARS‐CoV‐2 infection can manifest many rashes. However, thrombotic retiform purpura rarely occurs during COVID‐19 illness. Aggressive anti‐COVID‐19 therapy with a high‐dose steroid regimen led to rapid recovery. This immunothrombotic phenomenon likely represents a poor type 1 interferon response and complement activation on the endothelial surface in response to acute infection

Desempenho de lisímetro de pesagem hidráulica de baixo custo no semi-árido nordestino Low cost hydraulic weighing lysimeter performance in the semi arid northeast, Brazil

Medidas diretas de evapotranspiração de referência são importantes na avaliação e na calibração de métodos indiretos. Avaliou-se o desempenho de lisímetro de pesagem hidráulica de baixo custo, visando à determinação direta da evapotranspiração de referência (ETo), em área de assentamento rural no Semi-Árido nordestino. O lisímetro é de concepção simplificada, com travesseiros hidráulicos confeccionados com mangueira flexível de butil e revestida em náilon, interligados a um sistema manométrico com mercúrio e água. O equilíbrio do lisímetro foi estável, sendo o maior erro médio posicional de 3,93%. As calibrações geraram coeficientes de correlação superiores a 0,9993 e resoluções de leituras entre 0,095 e 0,134 mm. As leituras lisimétricas foram comparadas com estimativas da ETo obtidas, utilizando-se dos métodos de Penman-Monteith, Blaney-Criddle-FAO, Jensen-Haise e do Tanque Classe A-FAO. Adicionalmente, avaliou-se o desempenho de um tanque evaporimétrico simplificado, construído a partir de material reciclado, o qual vem sendo utilizado no manejo da irrigação em áreas de agricultura familiar. Todos os métodos analisados apresentaram bom desempenho, com medidas bem correlacionadas aàs do lisímetro, para o período estudado.<br>Direct evapotranspiration measurements are important to the calibration of indirect methods. The performance of a low cost hydraulic weighing lysimeter was evaluated, aiming to estimate the reference evapotranspiration (ETo) in a settlement area in the Semi Arid Brazilian northeast. The lysimeter presents a simplified design, with loading cells of butyl internally covered with nylon, connected to a manometric system with mercury and water. The lysimeter equilibrium was stable, with the largest positional average error of 3.93%. Calibrations produced correlation coefficients higher than 0.9993, and reading resolutions between 0.095 and 0.134 mm. Lysimeter readings were compared to ETo estimate Penman-Monteith, Blaney-Criddle FAO, Jensen-Haise, and Class A methods. Additionally, the performance of a simplified evaporimetric tank was evaluated, built with recycled material, which has been used for irrigation management in communal areas. All the considered methods produced good results, well correlated to the readings from the lysimeter, for the studied period